Importance of patient/inmate education

Friday morning I had to send an inmate out to the hospital 911. The Dx was acute exacerbation of gallstones.

As an ER nurse, I was not familiar with this inmate, but the yard nurse for his yard was in the ER at the time and explained the inmate's Hx. He was sent out to the hospital 911 two days ago for the same thing and was due for surgery. The inmate signed out AMA because he thought he could, "pee out the stones".

So, as I was prepping him prior to the arrival of the EMTs, I had a chance to advise him that when we (the DOC) send inmates out to the hospital, it's for a pretty good reason and he should think twice and a third time before signing out of the hospital against the doctor's recommendations.

Fast forward to 5:30 PM the same Friday. As I head to the pharmacy to get a stat order so that I can avoid sending a different inmate out to the hospital, I see that a transport vehicle is being inspected in the Sally-port. The officers tell me that they are taking someone back from the hospital. I don't know who it could be, so I ask to see the inmate right then and there and it's the gallstone inmate. The surgeon sent him right back to us because he does not perform surgery on Fridays (and probably because he didn't want to rearrange his schedule for someone who signed out AMA).

When I got back from the pharmacy, the inmate was still in the holding cell waiting to be seen by the doctor (who luckily for the inmate usually stays late to do charting). Since the doctor was the on-call for this weekend, I gave him a report on the inmate and as I clocked out, he was on the phone to the hospital to send him back out AGAIN!!!

As of yesterday by my quitting time, he had not returned.

The take-away is this: inmates and criminals are not for the most part very intelligent and generally very ignorant. So, when we as healthcare providers let someone refuse treatment, let's make sure he understands EXACTLY what he is refusing.

I blame this incident on the doctor/surgeon and the nurses at the hospital for not clarifying for the inmate that he had GALLstones and not KIDNEY stones!!!

The take-away is this: inmates and criminals are not for the most part very intelligent and generally very ignorant. So, when we as healthcare providers let someone refuse treatment, let's make sure he understands EXACTLY what he is refusing.

While I strongly agree with the latter part of that statement, I find the first part to be a dangerous generalization. For your own safety, and everyone around you, I would refrain from underestimating the I/P population in that manner.

Apr 25, '12

This is not a safety issue, but an education issue. I work in a Level 4 state prison - ALL inmates are dangerous regardless of their IQs. In addition, intelligence does not dictate the level or capability of committing violence.

While I strongly agree with the latter part of that statement, I find the first part to be a dangerous generalization. For your own safety, and everyone around you, I would refrain from underestimating the I/P population in that manner.

Apr 25, '12

I am considering working in a local state prison. I have been out of acute care for about 10 years, but there is a refresher class at the local university that I can take, and will take, prior to applying. I have experience in mental health/psych nursing and also home health, but aside from this, what else can you guys recommend that I do to prepare to be very successful at this?

Apr 25, '12

I recommend studying EMT materials. Nurses fill the role of nurse AND emergency response/first responder in the prison setting. Be prepared to be the only medical staff member responding to stabbings, assaults, murders, etc. Know your first responder protocols and be prepared to be videotaped while you are acting and responsible for that life that may be bleeding out in front of you. There's a reason why many of my RN co-workers became EMTs or self-studied EMT material after coming to the prison setting.

May 2, '12

I work as a nurse at a hospital that has the state's contract for DOC inmates. I agree with the need for education!! We recently had an inmate being admitted basically in acute (waiting to be dx as chronic) kidney failure secondary to naproxen use. He was given naproxen as a KOP for back pain, wasn't educated, and was taking it scheduled 3-4 times a day for 2 years. He will be inpatient with us for 4-6 weeks to earn the label of chonic kidney failure, and is already on dialysis MWF. Please please please educate!!!

As an aside, we do get alot of AMA when they realize that they are still on lock down, no tv's, no clocks, and no snacks. Many times if they are told fictously medical info from other inmates ie. peeing out a gallstone, and when they aren't getting the "service" they desire, no amount of teaching can change their minds....

I work as a nurse at a hospital that has the state's contract for DOC inmates. I agree with the need for education!! We recently had an inmate being admitted basically in acute (waiting to be dx as chronic) kidney failure secondary to naproxen use. He was given naproxen as a KOP for back pain, wasn't educated, and was taking it scheduled 3-4 times a day for 2 years. He will be inpatient with us for 4-6 weeks to earn the label of chonic kidney failure, and is already on dialysis MWF. Please please please educate!!!

As an aside, we do get alot of AMA when they realize that they are still on lock down, no tv's, no clocks, and no snacks. Many times if they are told fictously medical info from other inmates ie. peeing out a gallstone, and when they aren't getting the "service" they desire, no amount of teaching can change their minds....

I wonder how you know he wasn't educated?

Aug 5, '12

I have encountered this problem often doing Nurse Sick Call at my institution. I/ms with ongoing issues seem surprised when I discuss with them what their disease management is - as if no one has before. Now, it's a given they're good at manipulation and not always entirely bright, but the consistency I see of people not knowing the basics of handling poison ivy (ie, it spreads by touch, wash your hands often), hernias (don't pick up heavy objects), bacterial infections, and other really common things around our institution, I believe my fellow nurses often don't give their NSC patients any information at all.

Inmate or not, you have to educate your patients and advocate for your patients.

I am considering working in a local state prison. I have been out of acute care for about 10 years, but there is a refresher class at the local university that I can take, and will take, prior to applying. I have experience in mental health/psych nursing and also home health, but aside from this, what else can you guys recommend that I do to prepare to be very successful at this?

Assessment skills are key, because a lot of the people you will see will be trying to game you for secondary gain - whether it's for a trip to the hospital or just trying to get medication out of you. Correctional nursing requires a fairly high degree of independence. Especially at night you may be on your own, although there should be a physician and administrator on call to answer questions and issue orders if necessary.

Inmates run the gamut. I have had physicians, RNs and Ph. D.s and some to whom I had to explain why it was a good idea for them to shower. Some inmates are very aware of their conditions and the necessary treatments, while others are more ignorant about health care than you would believe possible. Explaining what you are doing and why goes a long way toward alleviating anxiety, and helps to improve compliance. Spend a little time early in the conversation determining each inmate's knowledge and comprehension level. You don't want to assume that the inmate is stupid, but you also don't want to assume a level of knowledge that may not be there.